Don’t neglect fever as ‘atypical’ dengue baffles doctors

Thirteen-year-old Arju has been suffering from fever for five days. Suddenly he fell unconscious and then had a seizure. His parents have taken him to the Dhaka Medical College Hospital (DMCH). Doctors with their previous experiences put him on a saline drip in what they call ‘fluid management’ of the dengue patient. The boy is now getting well.

Another boy, who cannot be named, has been admitted to a private hospital with his fever and blurring of vision. His platelet count, fall of which is a usual suspect of dengue, is okay. But doctors found his ‘dengue NS1 antigen’ test positive, which means he gets the mosquito-borne viral infection. He is also under watch with fluid management.

“In both cases, dengue involves the brain. This is rare. But now we are frequently getting this type of dengue patients,” said Dr Md Titu Miah, professor of medicine at the DMCH, who is treating both the patients.

He called it ‘atypical’ presentation of the otherwise seasonal fever, dengue, which has taken a bad turn this June, months before its usual peak season in September. Counting the cases becomes useless as any fever is a suspect of dengue to doctors.

“Now it (dengue) involves different organs like brain, heart, liver, and kidney. We also found in most of the critical patients, who came to the hospital, the condition worsened when their fever has gone. They went home relax, but after a couple of days fell ill again. We found fluid leakage began,” Prof Titu Miah said, suggesting adhering to follow-up for few days.

Dengue first struck Bangladesh in 2000, killing 93 people. Since 2003, the death rate has gradually declined with zero fatalities in some years.

But last year it took a devastating turn with over 10,000 infections and 26 deaths, according to the government statistics. This year, according to the government control room, so far 4,852 people were affected with only three deaths. The media, however, reported over 10 deaths citing different hospital sources.

According to the WHO, the global incidence of dengue has grown dramatically in recent decades. About half of the world's population is now at risk.

There is no specific treatment for dengue or severe dengue, but early detection and access to proper medical care lowers fatality rates below 1 percent. Dengue prevention and control depends on effective vector control measures.

Dengue mosquito, Aedes aegypti, breeds in clean water mostly in and around the houses. Household flower vase, buckets, tyre, and tubes where water remains stored are the perfect place for the breeding of the dengue mosquito.

“Still municipality authorities have a strong role to play. Dengue breeds around the home or abandoned or under-construction buildings where clear water can be accumulated. So they can spray (insecticides) there and at the same time raise awareness by distributing leaflets, handbills to the people who live around that place,” said Prof Mahmudur Rahman, former director of IEDCR.

Intermittent rains might be the reason for a June spike of dengue, Dr Meerjady Sabrina Flora, director of the government’s disease monitoring arm, IEDCR, told bdnews24.com.

“Globally, we have also noticed a rise of dengue cases in that period,” she said, citing examples of Malaysia and Thailand.

In Malaysia, 91 people died while 70 died in Thailand.

But for public, doctors advised them not to neglect fever.

“See a doctor when you have fever. And also follow it up few days even after (fever) subsides,” Prof Titu Miah said. He also urged doctors to follow the government guidelines in dengue treatment.

WARNING SIGN

No improvement of fever or worsening of the situation, persistent vomiting, severe abdominal pain, bleeding, a tendency to fall or giddiness, pale, cold and clammy hands and feet, less or no urine output for 4-6 hours, lethargy, restlessness, and sudden behavioural changes are some of the warning signs of dengue.

With co-morbid conditions such as pregnancy, elderly, infant, diabetes, blood pressure, chronic liver disease, and kidney disease, dengue demands special attention, according to Prof Titu Miah.

He suggested hospitals treat dengue patients separately under mosquito net for taking extra care. “This (special unit care) will also help spread the disease to others in the hospitals”.